My article discusses how and why government-run "universal health care" will inevitably compromise doctors' ability to uphold their Hippocratic Oath to treat their patients according to their best judgment and ability.
Her article shows that although veterinary and human medicine are extremely similar in terms of quality of care, the freer market for the former makes it substantially more affordable and accessible than the latter.
Non-subscribers can read the introduction to both articles online, but only subscribers can read the full pieces. Non-subscribers can also purchase PDFs of individual articles for $4.95. (Or if they like the samples of these and articles, they should subscribe to the journal!)
A shorter version of my article is also available to the public on the PajamasMedia website, under the title "ObamaCare vs. the Hippocratic Oath".
"If the government takes over health care, I will refuse to buy their package, refuse to pay the fine imposed, and make them arrest me. I will broadcast my refusal to cave to socialism on my website, on Facebook, to my students, in my lectures, and on the radio. I will fight this in the courts--or will the DC Fascists suspend the right to trial by jury? I suspect--and hope--that millions of Americans will do the same."
Jared Rhoads of the Lucidicus Project has a new OpEd, "All Talk, No Debate".
Reminder: It may be illegal in some circumstances to advocate someone else perform an illegal act. (I am not a lawyer and have no specialized knowledge about this.)
Note that Bernstein is announcing what he plans on doing (in the tradition of American civil disobedience to unjust laws). He also says he suspects and hopes others will also make a similar decision, but he does not explicitly advocate that other break the law.
Here at FIRM, we do not advocate that others perform violent illegal acts.
46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.
24% of physicians think they will try to retire early if a public option is implemented.
21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.
Update 2: The NEJM has updated the text of the page to reflect that the poll data comes from The Medicus Firm.
They note:
The opinions expressed in the article linked to above represent those of The Medicus Firm only. That article does not represent the opinions of the New England Journal of Medicine or the Massachusetts Medical Society.
Dr. Fred Shessel tells his patients: "You know, under ObamaCare I may not be able to take care of you to the best of my ability, or I am may not be able to see you at all."
Dr. Scott Barbour warns us: "There's gonna be only one choice for the government and that's gonna be to severely ration your care."
Jared Rhoads of the Lucidicus Project urges all Americans concerned about their future health care to, "Hold A Sign and Speak Out".
Ron Bachman of the NCPA warns that the proposed ObamaCare legislation could severely limit (or effectively kill) Health Savings Accounts. Read more in his March 5, 2010 paper, "Congress Declares War on HSAs".
Some analysts think that Pelosi is forging ahead, even though she may not have the votes from a combination of hope and fear -- hope that she'll pick up the final few votes once the process gets started, and fear that if she waits until after Easter recess, she'll lose even more votes.
Under the rules, the reconciliation process does not permit that debate. Reconciliation is therefore the wrong place for policy changes... In short, the reconciliation process appears to have lost its proper meaning. A vehicle designed for deficit reduction and fiscal responsibility has been hijacked...
(Link via LT.)
Similarly, Rossputin and other bloggers have been circulating this astounding video of various Democratic Senators' pious statements from 2005 (when they were in the minority) defending the filibuster as a vital protection against the "tyranny of the majority":
As then-Senator Biden declared (time-stamp 3:48): "I pray God when the Democrats take back control we don't make the kind of naked power grab you are doing". (Link via @AriArmstrong.)
Unfortunately, arguments about political hypocrisy or arguments about procedural details can only be secondary arguments in opposing ObamaCare.
But ultimately, the most important arguments to make are core fundamental moral and philosophical arguments about freedom, individual liberty, and the proper role of government, such as those offered by Dr. Leonard Peikoff in his essay, "Health Care Is Not A Right".
Unless we make the proper fundamental philosophical arguments, then secondary arguments about economics or political procedure will at most only delay (but not stop) the passage of some form of socialized medicine.
Fox News reports that President Obama will announce a scaled back version of his health plan on Wednesday. This may indicate a recognition by the Democrats that the full-fledged version of ObamaCare lacks sufficient support to pass with "reconciliation".
Given that it is described as "smaller in scope" than either the current House and Senate versions, it will presumably have to go through Congress again.
(The first half of the page is the original posting, ending with "I won't do either!"; the second half is Dr. Madianos' commentary. As long as the Medicare program exists, it will remain a permanent "political football" for patients, doctors, and other interest groups -- yet another reason that Medicare should be phased out and eventually eliminated.)
(Note: I generally agree with Senator Coburn's critique of the Democrats' proposals. However, the Coburn-Burr-Ryan-Nunes bill appears to be a very mixed bag, with some better elements and some bad statist elements. Hence, this should not be construed as an endorsement of that particular bill.)
I don't know much about the group Docs4PatientCare.org. But they seem to raising the right issues and asking the right questions. Many of their proposed reforms move us at least partially in the proper direction of a free market.
(I do have questions about their idea of "high risk pools" for patients with pre-existing conditions. If some patients are truly uninsurable, they may need to rely on private charity. The last thing we should do is create yet another government entitlement program. The D4PC statement is vague on whether private parties or the government would ultimately pay for these patients' insurance and/or care. I fully support the former, but would be opposed to the latter.)
One point they raise which bears repeating:
The AMA does NOT represent the majority of 'practicing" US physicians. Only 17% of US physicians belong to the AMA and most of these members are administrators, practice in academic medicine, retired or residents and students. Therefore, the AMA's endorsement of this legislation is meaningless and irrelevant.
Hence, to the extent that D4PC provides doctors who disagree with the AMA endorsement of ObamaCare with a vehicle to express their views and promote free-market reforms, I applaud their work!
Reconciliation Roundup By Paul Hsieh, MD @ 12:05 AM
A few quick updates on the proposed "reconciliation" tactic for ramming ObamaCare through the Congress:
RedState reports that according to Micheal E. Hammond, former General Counsel of the U.S. Senate Steering Committee (in consultation with Senate parliamentarian Alan Frumin), the reconciliation process is not a legally valid way to pass ObamaCare 2.0 in the Senate. (Via David Catron.)
My own opinion -- I don't know. So much of this depends on details of backroom arm-twisting and deal-making that we in the general public (by definition) won't be privy to.
Although it's not directly related to health care, it covers many of the same themes of freedom and individual rights vs statism and the entitlement mentality.
In this piece, I criticize the latest Obama Administration proposal to convert some of our private 401(k) retirement money into government annuities in order to help prop up the failing Social Security system. I also attempt to make the moral argument for the phasing out and eventual elimination of Social Security.
The Obama administration has just solicited public comment on their proposal to take money from Americans' private 401(k) retirement accounts and convert it into government-backed annuities. In other words, they want to take your money now to purchase U.S. Treasury bonds, then pay you a monthly sum later after you’ve retired.
Although this proposal is being initially portrayed as a voluntary choice, Americans already have the ability to purchase Treasury Bonds with their retirement money. Moreover, the Obama administration is considering making these annuities the default option. And as analyst Karl Denninger noted, "'choices' have a funny way of turning into mandates." Nor is his concern unjustified.
In 2008, Professor Teresa Ghilarducci of the New School of Social Research testified before Congress proposing a similar scheme to convert private 401(k) accounts into government-run "Guaranteed Retirement Accounts" that would pay a 3% return. And in 2008, the Argentinian government attempted to nationalize private retirement funds to help cover its runaway deficit.
As the U.S. Social Security system moves ever closer to bankruptcy, the billions of dollars Americans have saved in their private retirement accounts will become an increasingly tempting target for our politicians...
In the February 16, 2010 Wall Street Journal, Betsy McCaughey says the GOP should "Just Say No to the Health-Care Summit" until mandatory insurance is taken off the table.
And most Americans want the Congress to start over on health care, rather than taking the Democratic plan as the starting point of the summit.
Unfortunately, I think the Republicans who think it's an opportunity are badly mistaken. Unless they explicitly challenge and repudiate the basic premise of universal health care (i.e., that the government needs to somehow find a way to guarantee health care for all Americans), they'll merely play into the statists' hands.
We'll find out soon if the GOP has learned any lessons from the past, or they'll be suckered into offering political life support for the nearly-dead ObamaCare proposal.
The ObamaCare Nuclear Option By Paul Hsieh, MD @ 10:05 AM
I don't know how reliable this sort of procedural analysis is. But I wanted to pass this on to those who might be interested.
Conservatives need to be wary that the liberals are not done trying to pass ObamaCare. This may be a desperate last ditch effort to pass President Obama's signature item of his first two year, so be ready for this scenario to play out after the summit, if the summit does not bear any fruit. For those of you that thought ObamaCare had been laid to rest, remember that it is not over.
Again, I can't vouch for the reliability of the analysis, since much of this depends on backroom deals that by their very nature will not be accessible to most of the general public.
Filibuster For Me But Not For Thee By Paul Hsieh, MD @ 12:05 AM
I've already gotten used to seeing various pro-"universal health care" pundits arguing that we should get rid of the Senate filibuster because it causes "paralysis" and makes America "ungovernable".
Here's one typical example from New York Times columnist Paul Krugman, "America Is Not Yet Lost" (2/7/2010).
Basically, Eidelsen argues that when Democrats use the filibuster it's for the benefit of the majority of Americans, whereas when Republicans do so it's to thwart the majority.
Leaving aside the issue of whether it would be tenable to allow only one political party to use certain parliamentary tactics but not the other, I want to point out that thwarting the majority (in a controlled fashion) is precisely the idea.
In other words, it's a feature, not a bug.
Our founders did not intend America to be a majority-rule pure democracy. Instead, it was intended to be a constitutionally-limited republic, based on the principle of individual rights.
(I fully acknowledge that this principle has not always been consistently respected and/or adhered to during our history. Government-sanctioned violations of individual rights such as slavery represent some of America's most shameful actions.)
The filibuster helps insure that major legislation doesn't pass without some semblance of a broad consensus. Of course, a "consensus" on any issue does not guarantee that it will be correct. But in a rational (or at least semi-rational) political culture, this constraint will help weed out some of the worst ideas.
Hence to the extent that checks-and-balances like the filibuster slow down ill-considered legislation and help protect our individual rights, then I'm glad for this so-called "paralysis".
ObamaCare Supporters Not Giving Up By Paul Hsieh, MD @ 12:05 AM
According to the January 30, 2010 Los Angeles Times, the Democrats are going to put the health care issue on the back burner for now, then bring it up later once the political heat is off.
President Obama's campaign to overhaul the nation's healthcare system is officially on the back burner as Democrats turn to the task of stimulating job growth, but behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation.
They are meeting almost daily to plot legislative moves while gently persuading skittish rank-and-file lawmakers to back a sweeping bill.
This effort is deliberately being undertaken quietly as Democrats work to focus attention on more-popular initiatives to bring down unemployment, which the president said was a priority in his State of the Union address on Wednesday.
Many have concluded that the only hope for resuscitating the healthcare legislation is to push the issue off the front page and give lawmakers time to work out a new compromise and shift public perception of the bill.
And of course, these negotiations will be taking place "behind closed doors" -- precisely the tactics politicians employ when they are afraid of voter disapproval.
Hence, supporters of freedom and individual rights will have to maintain steady vigilance. We may have won this particular skirmish. But the war is a long ways from over...
Sen. Tom Harkin, the chairman of the Senate Health Committee, said negotiators from the White House, Senate and House reached a final deal on healthcare reform days before Scott Brown's victory in Massachusetts.
...Harkin said "we had an agreement, with the House, the White House and the Senate. We sent it to [the Congressional Budget Office] to get scored and then Tuesday happened and we didn't get it back." He said negotiators had an agreement in hand on Friday, Jan. 15.
Harkin made clear that negotiators had reached a final deal on the entire bill, not just the excise plans, which had been reported the previous day, Jan. 14.
Because of the Monday January 18 was Martin Luther King Day (i.e., a federal holiday), the CBO didn't have a chance to score the bill.
Scott Brown's victory in the Massachusetts special election for Senate the next day (Tuesday January 19) then torpedoed the deal.
I knew this country narrowly averted disaster that week. But I had no idea how close of a call it was...
"Reconciliation" Update By Paul Hsieh, MD @ 12:05 AM
The political battle in Washington DC continues to rage over the controversial "budget reconciliation" tactic that the Democrats are threatening to use to pass ObamaCare.
If this report from HotAir.com is accurate, the Democrats will use the "budget reconciliation" technique to ram ObamaCare through Congress.
Basically, the House has to first approve the Senate bill without changes. Then they would use the "budget reconcilation" technique to make changes in a pre-arranged deal to satisfy the various special interest groups. This only requires 51 votes in the Senate, not 60. This tactic is necessitated by the Scott Brown victory in Massachusetts which deprived them of their prior 60-vote supermajority.
The good news is that several Democrat Senators have already expressed opposition to using this method. (Whether they actually vote against it is a separate issue). So the Democrats may only have just barely over 50 votes they can count on. Which means if 1 or 2 more Democratic senators decide to oppose this tactic, then it will fail.
Here's an example of a great letter that David Crawford sent to his Senators from Washington state (reposted with his permission):
Senator XXX,
I have heard news that there is a plan to pass the Senate version of the health care bill with modifications made through "budget reconciliation", which requires fewer votes.
None of this seems to be confirmed, so I don't know what is true, but if there *is* such a plan, it seems to be a total subversion of the legislative process! Please do not support efforts that are obviously intended to force a major new set of laws and regulations on a people who are trying to make it clear that they don't want it.
The Massachusetts election was the latest of many efforts of voters to communicate that we do *not* support this massive intrusion into our health care. I believe the Senate bill was passed too early, without a real understanding of your constituents concerns.
We all want better health care, but the proposed changes may have a devastating effect on the existing system, especially at a time when the economy is still very unstable. Please listen to what your constituents are trying to tell you and vote NO on any "budget reconciliation" efforts to get ObamaCare into law.
...By the time I'm finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.
As temperatures cool, I want everyone to take another look at the plan we've proposed. There's a reason why many doctors, nurses and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors and stop insurance company abuses, let me know.
I'll offer my $0.02.
At the economic level, if our President wants to lower costs, he should try free market reforms.
At the philosophical level, he needs to re-examine the "morality of need" that says that one person's need gives him a moral claim on the goods and labor produced by another. This IBD editorial by Brook and Watkins is a good place to start.
...Senate Democrats will go to the House with a two-part deal.
First, the House will pass the Senate's Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.
How will Pelosi's deal fly with rambunctious liberal members of her majority who don't like the Senate bill, especially its failure to include a public option, put heavy fines on those who don't get insurance, and offering no income tax surcharge on the "rich"?
That's where the second part of the Pelosi-deal comes in.
Behind closed doors, Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members -- but only after the Senate bill is passed and signed into law by Obama.
This deal will be secured by a pledge from Reid and the Senate's Democratic caucus that they will make "fixes" to the Senate bill after it becomes law with Obama's John Hancock.
But you may ask what about the fact that, without Republican Scott Brown and independent Democrats such as Joe Lieberman, Reid simply doesn't have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation?
According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic senators indicating they will pass the major changes, or "fixes," the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.
Reid also has agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under "reconciliation" and don't require 60 Senate votes.
To pass the fixes, he won't need one Republican; he won't even need Joe Lieberman or wavering Democrats such as Jim Webb of Virginia.
His 52 pledged senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi's House and signed by Obama.
This plan, of course, is a total subversion of the legislative process...
As I said, I don't know how reliable this report is. But we shouldn't let our guard down yet...
Armentrout's Letter By Paul Hsieh, MD @ 12:05 AM
In the wake of the Massachusetts special election, Bryan Armentrout sent the following letter to his elected officials (reposted here with his permission):
I oppose any effort by the government to control my healthcare and I hope that the developments in Massachusetts will serve as a clear wake up call at your office. No one wants this legislation and the elections and polls strongly support this assertion.
I urge you to reverse your support and publically oppose healthcare legislation in any form.
If you continue your support for nationalized healthcare, I will actively work to remove you from office during the next election cycle.
My theme is that the recent election in Massachusetts (as well as the earlier November 2009 elections in NY, NJ, and VA) show that independent voters want limited government. Specifically, they want "the Democrats out of their pockets and the Republicans out of their bedrooms."
Here's the opening:
In the aftermath of Scott Brown's stunning upset election victory in Massachusetts, pundits will be debating the meaning and political implications for weeks to come. However, one fact is incontrovertibly clear. The race hinged on the independent voters.
In Massachusetts, 50% of the registered voters are independent, as opposed to 37% Democratic and 12% Republican. In this week's election, independents voted overwhelmingly for Brown, giving him a 52-to-47% victory -- in a state where Barack Obama easily won 62% of the vote in 2008. This enormous swing shows that the independents represent a powerful political force that neither party can take for granted.
Independents are also the driving force behind the tea party rallies. Many tea party supporters have been quite explicit in warning that their opposition to the policies of our current Democratic president and Congress should not be mistaken as automatic support for the Republicans.
So what do the independents want? In a word, limited government...
In general, I very much like his emphasis on allowing physicians and other practitioners to engage with patients using social media, without fear of legal repercussions. I know many physicians are reluctant even to use e-mail, precisely because of legal concerns.
Price transparency would also be a tremendous benefit if also coupled with genuine free-market reforms such as those proposed by John Mackey.
I would like to emphasize that in a free market, one would not need to mandate price transparency, as this would follow as a natural consequence of providers and patients each seeking their rational self-interest. Conversely, price transparency without a free market (for instance, in the type of heavily-regulated insurance market that Obama wants) would be meaningless.
As one small point of dissent, I think it's important not to conflate political power of governments with the economic power of corporations.
A disastrous intellectual package-deal, put over on us by the theoreticians of statism, is the equation of economic power with political power. You have heard it expressed in such bromides as: "A hungry man is not free," or "It makes no difference to a worker whether he takes orders from a businessman or from a bureaucrat." Most people accept these equivocations—and yet they know that the poorest laborer in America is freer and more secure than the richest commissar in Soviet Russia. What is the basic, the essential, the crucial principle that differentiates freedom from slavery? It is the principle of voluntary action versus physical coercion or compulsion.
The difference between political power and any other kind of social "power," between a government and any private organization, is the fact that a government holds a legal monopoly on the use of physical force.
I fully support limiting the power of government to its proper function of protecting individual rights. Otherwise, Dr. Hennefent is correct -- we would end up with rationing and "death panels".
In contrast, any economic power of insurers in a free market would be controlled by the voluntary actions of patients and providers who would be free to deal with (or not deal with) insurers based on their own rational self-interest. The government should only intervene if the insurance companies are guilty of commiting fraud or initiating force.
However, the fallout for the health care debate has already begun as Democrats in Congress are starting to shy away from ObamaCare. Even Barney Frank has expressed his doubts about its eventual passage.
Although we're still a long ways away from genuine free market reforms, last night's election may have halted the momentum towards a seemingly-inevitable government takeover of medicine. Perhaps now, some genuine free market reforms can be part of the health care debate.
I would like to highlight the fact that the Massachusetts election confirms what Duke University professor John Lewis observed in his superb article in the Fall 2009 issue of The Objective Standard entitled, "Obama's Atomic Bomb: The Ideological Clarity of the Democratic Agenda":
...This is the clarity that Obama has brought to the American political scene. To see a president’s clear and principled commitment to an ideology -- any ideology -- is precisely what America has needed for decades. This sight has helped many people understand the issues at a more fundamental level than they ever have.
Obama and his congressional allies have unwittingly launched a grass-roots movement that is actively questioning the role of government in our lives. Although a large portion of the protesters remains confused about the principles at stake, an increasing number are gaining clarity. They are coming to see the Democratic proposals for health-care "reform," for instance, not as a matter of new programs backed by good intentions, but as an attack on individual rights and an effort to impose a dictatorship -- as signs at tea parties attest. And many are beginning to see that the Republicans as well have been guilty of such attacks.
...Many Americans are now able to see Obama's plans as an assault on the founding principles of this nation. In addition, many Americans realize that time is running out -- that the future is here, today. These two factors are energizing otherwise nonpolitical Americans to literally rally around the flag, to confront their elected representatives, and to turn against the administration in droves.
Last night, the people of Massachusetts spoke loud and clear to express their rejection of ObamaCare and the underlying ideology.
Brown may not be a perfect candidate, but his election will buy supporters of free markets and individual some valuable time to promote our ideas.
As Obama Care becomes closer to reality, we in Colorado have the right to say "No." This is a chance for freedom loving people from across the state to come together and send the Colorado General assembly a simple message: Defend Colorado against Obama Care in the legislature, or we the people will do it at the ballot.
At the rally, we will be introducing language for a ballot initiative to amend the Colorado Constitution to excempt Colorado from Obama Care. We need to send a very strong and unified message to lawmakers that while we want them to say yes to defending Colorado, we are also ready, willing and able to move forward with the citizen initative process should the legislature fail us.
When: January 19th @ Noon Where: West steps, Capitol building
...Jon Caldara and the Independence Institute moved Colorado another step toward its own brand of health care reform, filing with state officials a proposed amendment to the Colorado Bill of Rights called the "Right to health care choice."
...The amendment would forbid government from forcing individuals to buy private health insurance -- an attempt to counter proposed federal legislation. It would preserve the rights of individuals to pay cash for health care services, and it would uphold the right of Coloradans to buy health insurance plans from providers in other states.
The House and Senate versions of proposed federal health care reform would greatly restrict the rights of individuals to make their own health care decisions. The proposed amendment, if upheld by the courts, could make Colorado a unique enclave of health care freedom of choice.
Willing patients should be able to purchase lab tests without having to go through a physician. The AMA (American Medical Association) is wrong on this issue, and that's another reason I'm not a member.
Instead of taking a principled stand against government regulations (and for free market reforms), they're probably thinking they can sway the political process to their liking by supporting (appeasing?) the greater statist now. If history is any guide, they'll soon learn the error of their ways. It's too bad we'll also have to pay the price for their folly.
(Only doctors may participate in the survey but all may view the results.)
The Congress' decision to hammer out the final details of the health care bill is getting lots of negative reaction from those who expected President Obama to live up to his promise of "transparency".
Betsy McCaughey discusses the constitutionality issue at: "ObamaCare vs. the Constitution" (New York Post, January 6, 2010).
McCaughey highlights one key point:
...Never before has the federal government intruded into decisions made by doctors for privately insured patients, except on narrow issues such as drug safety. Nothing in the Constitution permits it. But the Senate bill makes you enroll in a plan and then says that only doctors who do what the government dictates can be paid by your plan.
"Qualified plans" can contract only with a doctor who "implements such mechanisms to improve health-care quality as the [current or future] secretary [of Health and Human Services] may by regulation require" (Sec. 1311, p. 148-49). That covers all of medicine, from heart care to child birth, stents to mammograms.
Crawford's Letter By Paul Hsieh, MD @ 1:10 PM
Jason Crawford has started sending the following letter to his elected officials. With his permission, I am posting his text below:
Dear _______,
I am opposed to the health care bill for several reasons:
First, I just read an important editorial in Saturday's Wall Street Journal explaining why the health-care bill is unconstitutional in multiple ways. In particular: "the Constitution does not give Congress the power to require that Americans purchase health insurance."
Further, I oppose a mandate to buy insurance from a company where I can't negotiate freely.
Finally, I oppose any further restrictions on abortion rights.
In general, I oppose socialized medicine, "universal coverage", any "public option" or "single-payer" system, and any expansion of government control over health care.
Real reform would be increased freedom in health care, especially repeal of insurance mandates, opening insurance across state lines, and opening HSAs to everyone.
Health care is not a right! It is a service to be bought and paid for. And doctors, hospitals, and patients should have the right and the freedom to deal with each other any way they want.
- Jason A. Crawford
I encourage anyone who agrees with his ideas to send something similar to their elected officials. You can find their contact information at:
This is at variance with the standard recommendations from the American Cancer Society and American College of Radiology recommendations that women begin screening at age 40 and continue as long as they are in good health.
(Daniel B. Kopans, M.D., is a professor of radiology at Harvard Medical School and a senior radiologist in the breast imaging division at Massachusetts General Hospital.)
(Berg - American Radiology Services, Johns Hopkins Green Spring, Lutherville, MD; Hendrick - Department of Radiology, University of Colorado, Denver, CO; Kopans - Department of Radiology, Massachusetts General Hospital, Harvard University School of Medicine, Boston, MA; Smith - Cancer Control Sciences Department, American Cancer Society, Atlanta, GA)
How Leftists View America By Paul Hsieh, MD @ 12:10 AM
The leftist health care advocacy group Public Option Please recently held a contest for the best pro-public option art.
This past Saturday, hundreds of people gathered in the pouring rain in New Orleans, Louisiana, to tell Senator Harry Reid and Senator Mary Landrieu that they do not support a government takeover of health care. As you may know, Senator Reid was supposed to attend a fundraiser in New Orleans, but cancelled his plans to attend when he started taking heat for "asking Republicans for the weekend off."
Despite Reid's cancellation, the protest still happened. This video tells the story of the people who participated in the protest and why they want to see the health care bill rejected in the Senate:
Most of these ordinary Americans understand that government promises of "free" health care will result in a government takeover of their lives.
More such protests take place here in Colorado (and the rest of the country) tomorrow (12/15/2009) as part of the "Code Red" series of rallies.
Hint: Supporters of free market health care reform are fighting for individual rights, whereas slaveholders (and Senator Reid) want to violate [fill in the blank]...
The Importance of Mammograms By Paul Hsieh, MD @ 12:15 AM
The November 20, 2009 Denver Post published an OpEd by Dr. Lora Barke, one of my practice partners, rebutting the newly proposed government restrictions on mammograms.
Recently, the U.S. Preventive Services Task Force issued recommendations suggesting women refrain from getting their mammograms until age 50, and continue every two years thereafter.
With my colleagues at Invision Sally Jobe, I reject the USPSTF recommendations and support the American Cancer Society, American College of Radiology, Society of Breast Imaging, and many other respected professional organizations in their strong opposition to the new guidelines.
These new guidelines, if taken to their logical conclusion, will lead to diagnosing later stage cancer, resulting in more drug therapy, more radiation therapy and more late-stage intervention.
The American Cancer Society's (ACS) current screening guidelines state that women at average risk for breast cancer should have their first mammogram by age 40 and should repeat mammograms every one to two years thereafter. This can reduce the risk of dying of breast cancer by 20 to 25 percent for women aged 40 years or older. The ACS also says to continue routine mammograms beyond age 74, as long as the patient is in good health and has 10 years of life left.
A careful look at the most recent data shows us that about 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Furthermore, the risk of dying of breast cancer in women diagnosed in their 40s is reduced by 35 to 44 percent, not 15 percent as the USPSTF analysis incorrectly reported.
The USPSTF methodology greatly underestimates the benefit of modern mammography, while the ACS takes a more thorough and valid approach. The ACS looks at all the data used in issuing the USPSTF guidelines, more carefully reviews each individual study, and reviews many newer studies that have not been examined by the USPSTF. Despite this shortcoming, the USPSTF's own evidence review shows that mammography reduces the risk of dying in women in their 40s and women in their 50s at about the same rate.
Because fewer women develop breast cancer in their 40s compared with women in their 50s, the USPSTF has said the small benefit isn't worth the cost of screening in that age group. Among the costs are false positive examinations, including procedures. The USPSTF fails to cite the literature that reveals that women do not regard these costs as important drawbacks.
As for the screening interval, annual screening is especially important for women under age 55, and still produces better results for women 55-plus. As for false positives, remember that false positives do not double when comparing yearly mammograms to mammograms done every two years. In fact, research shows that going to the same high quality imaging facility on a regular basis reduces the likelihood of false findings.
Screening mammography in women in their 40s saves just about as many lives as it does for women in their 50s, and the breast cancer death rate in the U.S has decreased by 30 percent since 1990, primarily due to screening mammography. The USPSTF relies on old data, ignores compelling new data, creates confusion and ultimately concludes that it's just not worth it to save the lives of women in their 40s.
Screening mammography saves lives, and regular mammograms should remain an important part of women's preventive health care beginning at age 40.
Lora D. Barke, D.O., is the medical director of the Invision Sally Jobe Breast Network.
(Note: My writings for FIRM are my own opinion only, and do not necessarily reflect the views of any of my professional colleagues or practice partners.)
If you have any questions, his e-mail address is: reeddaly@gmail.com
His announcement follows below (also mirrored here):
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On Monday, November 16 we will be faxing and emailing copies of Dr.Peikoff's "Health Care is Not a Right" to the Senate, specifically persuadable Blue Dogs and GOP Senators on the Finance and HELP Committees.
The Finance and HELP Committees (Health, Education, Labor and Pensions) drafted the two versions of the Bill in the Senate, which must first be reconciled with one another and then with the House Bill.
You can help by sending copies to the Senators below or to those of your choice.
I have included the Youtube channels in case you also wish to send them messages or videos of Dr. Peikoff's speech. You can also post links to the speech on their Facebook walls.
